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Many Chest X-Rays in Children Are Unnecessary, Mayo Clinic Finds

Study addresses cost effectiveness

Researchers at the Mayo Clinic in Rochester, Minnesota, have found that some children are receiving chest X-rays that may be unnecessary and that offer no clinical benefit to the patient, according to a study presented December 3 at the annual meeting of the Radiological Society of North America, held in Chicago.

“Chest X-rays can be a valuable exam when ordered for the correct indications,” said Mayo Clinic radiologist Ann Packard, MD. “However, there are several indications where pediatric chest X-rays offer no benefit and likely should not be performed to decrease radiation dose and cost.”

Packard and her co-author, Kristen B. Thomas, MD, reviewed data from 719 pediatric chest X-ray exams ordered between 2008 and 2014 in the Mayo Clinic’s inpatient, outpatient, and emergency-room settings. The patients undergoing the exams ranged in age from newborn to 17 years old.

Of the 719 X-ray exams, 377 were ordered for chest pain; 185 indicated dizziness; 98 indicated syncope or presyncope; 21 indicated “spells” (i.e., a general feeling of being unwell or under distress); 37 indicated postural orthostatic hypotension (POTS); and one indicated cyclical vomiting. Eighty-two of the 719 exams were excluded because of congenital or other known heart disease, and other causes.

The researchers found that in approximately 88% of the remaining 637 patients, the exam did not alter clinical treatment.

None of the patients who underwent X-rays for syncope, spells, POTS, dizziness, or cyclical vomiting had a finding that affected treatment. Thirty-nine of the 330 non-excluded X-rays for chest pain were positive for pneumonia, bronchial inflammation, trauma, or other conditions.

“Approximately 12% of the chest X-rays for chest pain were positive and included respiratory symptoms, such as cough, fever, or trauma,” Packard said. “There were no positive findings in any chest X-ray for syncope, dizziness, spells, cyclical vomiting, or POTS for the past 5 years, even in our tertiary care center with referrals for rare diseases or unusual presentations.”

“This study addresses both of these issues, which is important not only for physicians but also for young patients and their parents,” she said. “I would like this research to help guide clinicians and deter them from ordering unnecessary exams, which offer no clinical benefit to the patient.”